摘要:

Previous work by our group had suggested that some Diagnostic Related Groups did not adequately compensate for patients with multiple complications and comorbidities. However, this question had never been studied for gynecology Diagnostic Related Groups. We analyzed resource consumption in the 15 gynecology Diagnostic Related Groups that were not stratified for complications or comorbidities using the new Diagnostic Related Group prospective “All Payor System” in effect at our hospital. Analysis of 2920 gynecology patients for a 3-year period by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in the gynecology Diagnostic Related Groups that were not stratified for complications or comorbidities demonstrated that patients with more complications and comorbidities per Diagnostic Related Group for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under Diagnostic Related Group payment, more outliers, and a higher mortality compared with patients in these same Diagnostic Related Groups with fewer complications and comorbidities. These findings suggest that new prospective Diagnostic Related Group All Payor Systems may be inequitable for certain groups of gynecology patients. Gynecology Diagnostic Related Groups should be stratified by the numbers and types of complications and comorbidities to more equitably reimburse hospitals under Diagnostic Related Group All Payor Systems.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The efficacy of Papanicolaou smear screening intervals of longer than 1 year is uncertain. Ninety-two symptomatic cases of invasive cervical cancer diagnosed between 1978-1983 in western Washington were identified with a population- based tumor registry. Using a random-digit-dialing technique, 178 controls from the Same geographic area were selected. A structured telephone interview was used to ascertain screening history and risk factors for cervical cancer. The mean interval between Papanicolaou smears in the 10 years preceding diagnosis (cases) or the reference date (controls) was calculated. The risk of squamous cell cervical cancer was increased 3.9 times (95% confidence interval 1.2-12.3) for women with Papanicolaou smears at 3-year intervals compared with women with annual screening. For women who had not had a Papanicolaou smear in the preceding 10 years, this risk increased 12.3 times (95% confidence interval 2.5-60.6). For screening intervals of 2 years, the risk of cervical cancer (all cell types) was not increased (relative risk 1.01; 95% confidence interval 0.43- 2.37). The presence of well-known risk factors for cervical cancer did not modify these results. These data suggest an increasing risk of cervical cancer if Papanicolaou smear screening intervals exceed 2 years.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A total of 18 infertile patients with hysterosalpingographic diagnosis of bifid uterus underwent magnetic resonance imaging (MRI) and subsequent laparoscopy or laparotomy to evaluate the capability of MRI to differentiate among the various classes of the malformation. Magnetic resonance imaging identified both bicornuate uteri correctly, both didelphic uteri, nine of the 12 partial septate uteri, and both complete septate uteri. The method demonstrated a sensitivity of 100% and a specificity of 78.6% in demonstrating cervical prolongation of the spur. Compared with laparoscopy, MRI is less expensive and less invasive, and can also be performed in patients with extensive adhesions. However, it has the disadvantage of not providing information on tubal conditions or on the presence of minimal and mild endometriosis.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this prospective investigation was to determine the effect of bacteriostatic lubricant on group B streptococcal cultures obtained from the lower genital tract of pregnant women. Fifty pregnant women with intact membranes who recently had genital tract cultures for group B streptococci were evaluated. The study group consisted of 25 women who had positive cultures, and the control group comprised 25 women who had negative cultures. All patients underwent examination with a sterile nonlubricated speculum within 7 days of the previously obtained cultures. Secretions from the endocervix and from the posterior vaginal wall near the introitus were collected with a sterile cotton-tipped applicator and inoculated directly onto a selective blood agar culture plate. The sterile speculum was removed and a digital examination performed using bacteriostatic lubricant. A second sterile speculum was then inserted into the vagina and another group B streptococcal culture was obtained. There was 100% correlation between the cultures obtained before and after the vaginal examination. We conclude that use of bacteriostatic lubricant does not alter the recovery of group B streptococci from the genital tract of pregnant women with intact membranes.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Surgical and pathology data were analyzed with the quantitative serum hCG values from 131 patients with tubal pregnancies. The hCG value correlated with both the size and contents of the eccyesis. Patients with ruptured tubal pregnancies had significantly greater serum hCG levels than did those with intact tubal gestations. Isthmic tubal pregnancies were associated with more frequent rupture and larger amounts of hemoperitoneum than were pregnancies in the ampullary segment of the tube. Tubal rupture with hCG values below 100 mlU/mL occurred in two isthmic pregnancies but in no ampullary pregnancies. With serum hCG levels below 300 mlU/mL, significant hemorrhage did not occur unless the tube was ruptured. Half of the patients had hCG levels sufficient to use a vaginal sonographic hCG discriminatory zone to assist in the diagnosis. A maximum of 15% of tubal pregnancies may be diagnosed by ultrasonographic detection of adnexal cardiac activity. A serum hCG assay sensitive to 10 mlU/mL will detect nearly all tubal pregnancies. The hCG level frequently has diagnostic value when used in conjunction with vaginal sonography. At hCG levels of 100 mlU/mL or less, tubal rupture is very unlikely for ampullary, but not for isthmic, tubal pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Several studies have shown that treatment with a gonadotropin- releasing hormone (GnRH) analogue can reduce uterine volume in women with leiomyomata. However, no study to date has used a controlled population for comparison, nor has any study delineated the physiologic mechanism of volume reduction. We performed a double-blind, placebo-controlled study of a depot form of a GnRH analogue (leuprolide) given monthly for 24 weeks in 11 patients with symptomatic uterine leiomyomata. Patients initially treated with placebo were subsequently treated with active drug for 24 weeks. Magnetic resonance imaging was used to identify specifically the total uterine volume, total myoma volume, and total non-myoma volume. Treated patients had a significant reduction in total uterine and non-myoma volumes as compared with placebo patients (P < .02). Total myoma volume was also reduced, but only to a P=.06 level. Pre- versus post-therapy values for all 11 patients showed significant reduction in all three volumes (P < .02). Most symptoms were markedly improved. By 24 weeks post-therapy, all volumes had returned to baseline levels, although symptomatic improvement commonly persisted. The non-myoma volume was proportionally reduced to a greater extent than the myoma volume (42.7 versus 30.4%), and we therefore could explain the reenlargement seen when treatment was discontinued. Side effects were well tolerated and there were no study dropouts. We conclude that temporary hypoestrogenism induced by GnRH analogues can produce significant though temporary reduction in uterine volumes, and that the non-myoma volume is responsible for much of the reduction and reenlargement. The treatment is well tolerated, and symptomatic benefits may well persist even with return of uterine volumes to pre-treatment size.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

One thousand twenty inductions of labor by amniotomy and continuous infusion of oxytocin at the Royal Women's Hospital were reviewed. Three different starting rates of infusion of oxytocin were used by altering the concentration to 2, 5, or 10 U/L. There was no difference in success of induction as measured by induction-to-delivery interval or by rate of vaginal, delivery using higher initial concentrations of oxytocin. Higher pre-induction Bishop scores were associated with shorter labors and more vaginal deliveries. This study was retrospective and nonrandomized, but within these limits it suggests that “low-dose” oxytocin infusion is effective for induction of labor and may be associated with fewer hazards than are higher doses.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In a randomized study, 94 patients with term pregnancies underwent augmentation of labor with either continuous or pulsed (every 8 minutes) intravenous oxytocin infusion. There were no significant differences with respect to the maternal characteristics, cervical dilatation and effacement, induction-to-labor interval, induction-to-delivery interval, cesarean section rate, analgesia for labor, or low Apgar scores. No hyperstimulation was noted in either group. In each group, 20% of the patients had dysfunctional labor patterns, with coupling and tripling of the uterine contractions. The mean ± SEM oxytocin administered in the pulsed-infusion group was significantly lower than that in the continuous-infusion group (2.1 ± 0.4 versus 4.1 ± 0.4 mU/minute; P < .001). The mean ± SEM total amount of oxytocin administered was 1300 ± 332 mU for the pulsed group and 1803 ± 302 mU for the continuous group, indicating that lower amounts of oxytocin were required for pulsed administration. Our study demonstrates that pulsatile administration of oxytocin is similar in efficacy to our standard continuous oxytocin infusion and requires a lower total amount and rate of oxytocin administered, which may afford a greater margin of safety.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Human neutrophil elastase may be a mediator of vascular damage, and enhanced neutrophil reactivity could contribute to the susceptibility of pregnant diabetic women to vascular complications. Elevated plasma levels of neutrophil elastase will reflect neutrophil activation in vivo. The aim of this study was to determine whether neutrophil activation occurs in uncomplicated diabetic pregnancy. We studied 30 normal nonpregnant women, 20 nonpregnant diabetic women, 32 nondiabetic women with normal pregnancies, and 17 insulin-requiring pregnant diabetic patients. Plasma neutrophil elastase was measured by radioimmunoassay. There was a significantly higher concentration of plasma neutrophil elastase in normal pregnant women compared with the nonpregnant group (P < .001). The nonpregnant diabetic group had significantly higher concentrations than the normal nonpregnant group (P < .002). The pregnant diabetic group had significantly higher concentrations than the nonpregnant diabetic group (P < .0001) and the normal pregnant group (P < .05). The high concentrations of plasma neutrophil elastase may contribute to the greater sensitivity of pregnant diabetic patients to vascular complications.

ISSN:0029-7844    

出版商:OVID    

年代:1989

数据来源: OVID